Backup Documents 02/14/2012 Item #16F 4ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16F 4
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's signature. draw a line through routing lines #1 through #4_ complete the checklist and forward to Sue Filson (line #5)_
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1.
appropriate-
Initial
Applicable)
2.
2/14/12
Agenda Item Number
16F If
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
EMS 2012 Permit and COPCN
Number of Original
2
5. Ian Mitchell, Supervisor
Board of County Commissioners
Documents Attached
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Artie Bay
Phone Number
252 -3740
Contact
appropriate-
Initial
Applicable)
Agenda Date Item was
2/14/12
Agenda Item Number
16F If
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
EMS 2012 Permit and COPCN
Number of Original
2
Attached
I
Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate-
Initial
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 2/14/12 (enter date) and all
changes made during the meeting have been incorporated in the attached document.
The County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16F 4
MEMORANDUM
Date: February 15, 2012
To: Artie Bay
EMS, Operations Analyst
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: COCPN & Permit
Attached please find one (1) ORIGINAL of the COCPN & PERMIT referenced above,
(Agenda Item #16F4) approved by the Collier County Board of County Commissioners
on Tuesday, February 14, 2012.
The Minutes and Records Department has retained a copy of the Original
documents to be kept in the Board's Official Records.
If you have any questions, please call me at 252 -7240.
Thank you.
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16F 4
COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2012
Name of Service: Collier County Emergency Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners_
Principal Address of Service: 8075 Lely Cultural Parkway, Naples, Florida 34113
Business Telephone: (239) 252 -3740
Emergency Telephone: 9 -1 -1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty: 24 ground units (ambulances)
Number of Ambulances on 12 hour duty
Number of reserve Ambulances
Number of non - transport ALS engines
Number of Medivac helicopter:
1 ground unit (as needed during season taken from reserve fleet)
10
12
See attachment "A" for description of vehicles.
This permit, as provided in Ordinance 04 -12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the
expiration date hereon, except that this permit may be revoked by the Board of County Commissioners of Collier
County at any time the service named herein shall fail to comply with any local, state or federal laws or regulation
applicable to the provision of Emergency Medical Services.
Issued and approved this
1q-th
.��A9D 3F
--
wight E,-b C IC ��i► "
At st as tc awl esil _..y rk
Approved as W foAm gal sufficiency:
day of re '2012.
Jenni B. White, Assistant County Attorney
BOARD OF COUNTY COMMISSSIONERS
COLLI R COUNTY, FLORIDA 7uk W. (" t
Fred W. Coyle, Chairman
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